HIPAA Compliance

HIPAA is Health Insurance Portability and Accountability Act of 1996-A law mandating that anyone belonging to a group health insurance plan must be allowed to purchase health insurance within an interval of time beginning when the previous coverage is lost. The law protects employees, especially those with long-term health conditions who may be reluctant to leave jobs because they are afraid pre-existing condition clauses will limit coverage of any such conditions under a new insurance plan, from losing health insurance due to a change in employment status. This act was basically designed to protect the privacy rights of individuals with regard to their confidential medical records. The act greatly restricts the dissemination and transmittal of personal patient information and has dramatically affected the way healthcare information is handled. HIPAA regulations have also tried to restrict the use of preexisting condition exclusions, create special enrollment periods and prohibit discrimination based on health-status related conditions in enrollment and premiums.

HIPAA - Primary objectives

This act was a result of congressional health care reform proponents to reform healthcare. The four primary objectives it serves to achieve are:

• Reduce healthcare fraud and abuse
• Assure health insurance portability by eliminating job-lock due to pre-existing medical conditions
• Enforce standards for health information
• Guarantee security, privacy, and confidentiality of patient health information

Of the four primary objectives, the fourth objective has the most impact on medical transcription since it deals with handling and transfer of sensitive information of patient health data usually in electronic form. All transcription organizations, therefore, must be able to support two requirements:

1. Ensure the security and confidentiality of the patient’s Protected Health Information and

2. Maintain an audit trail of all individuals who have had access to Protected Health Information.

This means that transcription service providers must implement technology and business processes in their operation to support these two major requirements.

HIPAA Regulations and its reach-HIPPA regulations have been devised to have broad application with a variety of extensions. These provisions extend to all health care providers who transmit health records in an electronic format and health care billing companies. The Act refers to these organizations as "Covered Entities". Most Medical Transcription Services and their employees are not considered "Covered Entities" under the Act unless their organization also engages in services that put them in the category of "Covered Entity". Medical Transcription Services are typically regarded under the Act as "Business Associates".

 

Covered Entity and Business Associate

 

HIPAA defines a Covered Entity (CE) as a health plan, a healthcare clearinghouse, or a healthcare provider who transmits any health information in electronic form in connection with an HIPAA transaction. A physician’s office thereby would fall under the category of a Covered Entity.

The Act defines a Business Associate as "any person or organization that performs a function or activity on behalf of a Covered Entity, but is not part of the Covered Entity's workforce (employees, volunteers, trainees and others) under the Covered Entity's direct control, regardless of whether they are paid by the Covered Entity." A medical transcription service provider would be classified under the definition of a Business Associate.

As a Business Associate, the Medical Transcription Service may not be directly governed by HIPAA regulations. But however, indirectly, the Business Associates are governed in accordance with the fact that Covered Entities are required to obtain written assurances from the Business Associates that they deal with to ensure that patient identifying information is appropriately safeguarded. These written assurances must be included in a written contract between the Covered Entity and the Business Associate.

HIPAA & Independent Medical Transcriptionists?

Medical transcriptionists who operate as Independent Contractors to Medical Transcription Services (Business Associates) and who have direct access to patient health information are referred to by the Act as "Third Parties." Third Parties must have a written contract with the Business Associate for whom they provide contract services to assure that patient information conveyed to them will be appropriately safeguarded and that all electronic data transmissions between the Third Party and the Business Associate are conducted in accordance with the approved national standard. This contract should be similar in nature and scope to the contract between the Business Associate and the coveted entity.

Deadline for Complying with guidelines of HIPAA?
HIPAA act requires that healthcare organizations insurers and payors that have been using any electronic means of storing patient data and performing claims submission must comply with this rule by April 14, 2003. Since medical transcription deals with handling and storing patient data in electronic form, it is necessary that all such organizations must comply with this deadline. Small health care plans will have until April 14, 2004, to become completely compliant. However, all other covered entities must become fully compliant by April 14, 2003.

Standards prescribed for Transmittal of Electronic Patient Information - HIPAA act requires that healthcare organizations insurers and payors that have been using any electronic means of storing patient data and performing claims submission must comply with this rule by April 14, 2003. Since medical transcription deals with handling and storing patient data in electronic form, it is necessary that all such organizations must comply with this deadline.

Internet & HIPAA compliance-With advancing technology, the internet has become the major source of electronic data transmission over the years and will surely continue to do so. Hence, it becomes necessary on the part of medical transcription service provider to use encryption and password protection to prevent unauthorized access to any patient information. Dictations done on a telephone does not need to be encrypted. However, voice files transmitted by portable recorders should be encrypted prior to transmission over the Internet. 

Transcribed documents must be sent back to the healthcare provider also in a secured manner using encrypted email or a secure FTP site or may be faxed with a disclaimer statement explaining the confidential nature of the document. However, use of tapes lends a high degree of a doubt since there is no way to verify an audit trail as to who has had the tape and who listened to patient data on the tape. If the tape is lost, one cannot guarantee the security of the information on it.

Other Key Provisions of the Act - The primary focus of the Act is to restrict the leakage and dissemination of patient health care information. The conditions under which information can be conveyed are very explicitly stated. The rules specifically pertain to health information that is transmitted or maintained in any form be it oral, paper, electronic, etc and which contains patient identifying information. Patient identifying information includes such things as name, address, social security number, phone number, and any other information, which could be used to identify an individual.

In order to be compliant with the rules and regulations of HIPAA, covered entities must implement measures to ensure that patient information is protected in accordance with the provisions of the Act. Specifically:

1. A proper written proof must be provided to individuals telling them as to how their information will be used and to whom it will be disseminated (i.e. to insurance and billing companies, or other health care practitioners).

2. Similarly, a written consent should also be obtained from the individual allowing for the use and maintenance of personal information as provided for by the Act.

3. Disclosure of information for any other purpose must be done always after documented specific authorization from the individual.

4. All efforts must be made by covered entities to minimize the dispersal of patient information through any means.

5. Covered entities must establish and maintain adequate administrative, technical and physical measures to ensure that all privacy requirements are upheld within the organization.

6. Business Associate must be directed specifically to safeguard all patient related information in the best possible way and covered entities should periodically review the standards of security and confidentiality of their Business Associate.

Penalty imposition for the non-compliance-The total amount of civil penalties for multiple violations by a Covered Entity during a calendar year is capped at $25,000.

HIPAA also provides from criminal liability for Covered Entities for knowingly obtaining or disclosing individually identifiable health information. The maximum penalty is a fine of $50,000 and imprisonment of one year. If the offense is committed under false pretenses, the maximum penalty is a fine of $100,000 and imprisonment of five years. If the offense is committed with the intent to sell, transfer or use individually identifiable health information for commercial advantage, personal gain or malicious harm, the maximum penalty is a fine of $250,000 and imprisonment of ten years.

Both Civil and criminal penalties can be imposed for noncompliance with HIPAA. The truss of these penalties is usually directed against Covered Entities but not directed directly against Business Associates. However, indirectly, the business Associates do come under penalty imposition since they are contractually obligated to comply with these regulations.

Rights of the patient under HIPAA provides the patient with many new rights in relation to their healthcare documentation. Some of them include:

• Right to review their entire medical record and data.
• Right to request changes within documentation (though this comes under the preview of the physician who can deny for specific reasons
• Right to request documentation every time their information was accessed, along with the identity of the individual accessing the document with the specific reason for doing so.
• Right to know how much of the information was shared.
• Right to know what the Covered Entity’s policies and procedures are for security and privacy.

How to Become a Medical Transcriptionist

The Basics

Medical transcriptionists create reports and other administrative documents from physicians’ dictated recordings. In addition to transcribing, you’ll edit information for grammar errors and proper usage of medical terms in a patient’s records. You’ll need an in-depth knowledge of medical terminology, anatomy, medical procedures and treatments, and pharmacology—as well as a high degree of attention to detail. Medical transcriptionists must also be aware of the legal standards and requirements that apply to health records.

Where you’ll work: Hospitals, clinics, physicians’ offices, nursing homes, public health agencies and home health care agencies. Some medical transcriptionists work at home as employees of transcription businesses or as independent contractors.

Education and Training

In addition to your degree, you’ll need to complete a certified medical transcription training program, usually a 6-month to the 2-year certificate, diploma or associate’s degree program.

Graduates must understand medical terms, their meanings, spelling, and pronunciation, and possess hands-on transcription experience.

Coursework generally includes the following subjects:

•     English composition and grammar
•     Computer applications
•     Medical terminology
•     Pathology
•     Anatomy and physiology
•     Medical transcription skills 

Medical Transcriptionist Certification

Certification is optional but highly recommended. Medical transcriptionists who pass the national exam given by the Association for Healthcare Documentation Integrity (AHDI) will earn the title Certified Medical Transcriptionist (CMT). Every 3 years, CMTs must earn continuing education credits to be re-certified.

Source: allalliedhealthschools.com

HEALTHCARE AND NURSING JOBS YOU CAN DO AT HOME

Work-at-home jobs are all the rage right now, but if you’re a nurse or other healthcare worker, you probably think WAH isn’t an option for you. Guess again, because there are more and more healthcare and nursing jobs being introduced for those who want to or need to work at home.

The Top Non-Nursing WAH Jobs

Probably the easiest WAH medical job to break into is medical transcription. Many people already do WAH transcription from audio recordings without any formal training, so breaking into medical transcription is a matter of either having a background in healthcare that makes you familiar with the terminology or taking courses to tackle that complex lingo from doctors. Allied Health Schools recommends you need to complete a six-month to a two-year training course in addition to having a high school diploma, but if you have transcription experience, healthcare experience, or a combination of both, you may find entry-level jobs that will work with you before completing a training course and certification.

However, if you want to get into WAH medical billing and coding, you will need a certification in almost any job you apply for, including entry-level positions. There are different levels of certification and in the first level, you can apply to take the test without formal training if you have experience doing medical coding. That will be rare unless you are a semi-retired or retired nurse looking to switch careers and have extensive coding experience working as a case manager or an MDS nurse in long-term care. But yes, you’ll still need to take that test and get certified.

Bear in mind that some medical coding programs can take as long as getting a basic nursing certification to become an LPN if you have an interest in becoming a nurse. However, you’ll be hard-pressed to find LPN jobs you can do from home. Almost all work-at-home nursing jobs go to a higher level of nursing, Registered Nurses, or RNs.

Can You Really Work At Home As A Nurse?

When most people think of nursing, they think of hands-on care and wonder what a nurse can do from a home office. Some people consider working as a home health case manager as a WAH position, but that’s not really the case as home health case managers have to go into the office daily as well as attend meetings and care conferences in addition to their actual patient visits. Fortis notes that one exception to that rule would be the after-hours triage nurse, who goes on-call when the office closes and the case managers go home for the day.

An after-hours nurse works from their home, taking calls from the telephone triage nurse when calls from patients come in needing assistance. If the telephone triage nurse can’t handle the problem over the phone, he or she will call the nurses working after-hours to have them make a visit and address the issue. Nurses who work exclusively doing after-hours work do not have a patient caseload, so they are not required to attend patient care conferences or make regularly scheduled visits. They simply work their shifts from home, waiting for the next call.

It’s an unpredictable job position as some nights the on-call or after-hours nurse will be busy all night, or other nights there may only be one or two calls all night. You just never know.

WAH Nursing By Telephone

You may have noticed that the after-hours nurse receives their assignments from the telephone triage nurse. With a few exceptions where home health or hospice companies require their triage nurses to be on site to take calls, the telephone triage nurse is generally a true WAH position. Like the on-call nurse that makes visits, this can be very unpredictable, so you may be receiving calls one after another all night from 5 p.m. to when the office opens the next morning, or you may only have a couple of calls. Many home health and hospice companies also go by a schedule of seven days on and seven days off for their after-hours staff, particularly the telephone triage nurse who never goes out to make visits.

Companies like IntellaTriage handle triage calls for multiple hospices all over the country, so you can expect to stay fairly busy even at night, but also you will have to learn multiple systems for the different hospice agencies. That includes their electronic charting and their protocols. Don’t be surprised if each individual hospice you’re covering has a different script for simply answering the phone. If you’re very organized and set your WAH office up the right way, this isn’t nearly as bad as it sounds. Tip: keep your phone in a space big enough that you can have printouts of each script right by the phone, surrounding it. (IntellaTriage’s phone system shows which hospice is calling on the caller-ID before you pick up so you know which script to use.)

You’ll have to carry a lot of nursing licenses and you will probably need to reside in one of the nursing compact states to cover a wide territory, plus get licenses in states such as Florida, California, and more depending on where each agency being serviced is located. Also, note this agency does not have a triaging script. You will be relying on your own knowledge and individual company protocols for advising clients, unlike most insurance nurse hotline jobs.

WAH Nurse Hotline Jobs

If you want an alternative to doing telephone triage for a home health or hospice agency, you can also work from home for an insurance company nurse hotline. These lines operate 24/7/365 so a daytime schedule is possible. However, expect to spend some time paying your dues working evenings and nights for a while until daytime positions open up as they are in demand.

Carenet, based in San Antonio, manages multiple insurance company nurse hotlines, and you must do your training on site in San Antonio over the course of two weeks. Once your training is complete, if you aren’t local to San Antonio, you proceed directly to working from home. If you are local and able to go into the call center, you start out working on-site and become eligible to move to WAH based on performance.

You also have to show that you have a work space that meets HIPAA privacy guidelines for handling healthcare information. That means having a separate lockable room for your computer and any documents related to work, even if you live alone. You must have high-speed, secure internet access. Also, be forewarned that there are expectations for the amount of time you take to finish calls and the average number of calls you take per hour. If you are not on a call for more than two minutes, don’t be surprised if you get a text message from the shift supervisor wondering why you aren’t taking the next call.

Nurses use a computer program that presents a series of questions starting with the most critical scenario down to the least severe. You will be expected to ask the questions in exact order and not deviate from that recommendation script. All the questions are yes/no questions, and when the caller answers “yes,” it tells you what recommendations to give. You must follow this protocol to the letter.

The work-at-home trend now includes healthcare, so even if you thought working from your home office was nothing more than a dream, there are options for nurses and other medical staff to make a big change that can balance your personal and professional lives.

Source: http://www.inquisitr.com

History of Medical Transcription

Medical Records are not a new invention

Records have been kept on patient care since people first developed the ability to write. At the beginning of the 20th century, stenographers entered the scene who took the doctor’s dictation in shorthand. This method was used until the invention of audio recording.

With that ability, doctors would talk into a mic, record their report and a transcriptionist would type it up on a mechanical typewriter, and the paperwork filed in the patient chart.

The Evolution of Medical Transcription Technologies

Dictabelts and Dictaphone Transcribers

Note the blue plastic circular “Dictabelt,” which was cut by a needle in the dictation process, much like the old 45 and later music records.

Dictabelt

Most hospitals used the Dictaphone plastic belts. They slipped onto a cylinder in the transcriber unit and moved it forward and backward with a foot pedal.

Typewriters

Typewriters like the IBM Selectric typewriter were a wonderful improvement over the mechanical typewriters since it allowed you to insert a tape and hit a typo error then type over it to make the correction.

They also had a stroke counter so you could multiply the strokes by 5 to get a word count, which was how many transcribers would charge for their services.

Birth of Remote Dictation

The first remote dial-in systems consisted of an approximate 3’x3’x6” box with miles of recording tape inside and recorder-coupler-connected to a couple of telephone lines. The dictator would call in, hear a beep, then dictate.

Word Processors

With paper tape about one inch wide, each keystroke on a typewriter punched a hole in the tape. Once a document was completed the tape was fed through a reader to produce the printed output.

When the tape tore, which was often, a splicer was provided allowing the operator to neatly glue the tape back together.

Computer Processors

In the mid-80s came a major breakthrough with computer word processors. When the first word processors with the 8088 chip emerged, combined with WordPerfect 4.0 and Pro-Comm (software), transcriptionists were able to be more productive and move files from their site to customers’ offices.

DOS (with Windows) was used in the word processing business (and virtually everything else for a time). The word processing software that was primarily used at the time was WordPerfect, however, Microsoft figured out how to get an edge so MSWord became the standard for transcription.

Hooking a computer to a modem then allowed pools of transcriptionists to access remote customers who had their own dictation systems. Dialing into a hospital several thousand miles away, transcribing the records and digitally sending them for in-house printing was a huge milestone.

Word processing software as well as incorporating templates and word expanders greatly increased productivity.

Voice Dictation

In the late 1980s, voice recognition was introduced. It allowed computer software to translate a voice record into a digital report; however, with all of the idiosyncracies of medical dictation and its various dictators (slow vs fast speaking, non-native-English speaking doctors) created a huge error margin. Then the transcriptionist became an editor who would review the digital record, often listening to the voice record to edit the completed file.

Current Politics in Healthcare Affecting Transcription

The last few years, the Electronic Medical Records, now mandated by law, and its various failures makes the healthcare news on a daily basis. Many vendors jumped into the arena and sold software to providers (hospitals, doctors, etc.). However, since no common standard was ever developed or required, none of the systems talk to each other which eliminates the primary reason they were developed – easy access to a centralized record = better patient care.

Clearly, digitalizing medical records and managing control access presents huge opportunities for successful career considerations. Medical transcriptionists have a huge knowledge of medical terms and of medicine generally, including anatomy, physiology, pharmacy, diseases, disease processes, laboratory procedures, x-ray and radiological procedures, and surgery have become major interpreters in the health information system and medical records documentation. Their contribution to healthcare is enormous.

Wherever medical records migrate, medical transcriptionists will be in the vanguard.

Source: www.med-certification.com